Conflict of Interest, DSM-5, and the APA

Sandra Steingard, M.D.

January 25, 2014

The point of this post is to bring your attention to the writings of some fellow bloggers, particularly 1 Boring Old Man (1BOM).  For the past 6 months , but particularly in the past month, he has brought attention to a conflict of interest with David Kupfer, the head of the APA’s DSM-5 task force (here, here, here, and here).

The story is a bit arcane and I suggest that for full details, you read his blogs as well as one by Bernard Carroll and Neuroskeptic. It is Dr. Carroll who actually brought this COI to our attention.

This is the outline of the story. From its inception, there was an interest in adding a dimensional component to the DSM. When I first learned of this, I thought they meant that this would replace the categorical diagnoses. What I have learned, however, is that the dimensions are intended to supplement the categories so they would allow us to quantify the degree to which one suffered from, let’s say, Major Depressive Disorder. I will leave aside for now the merits of this approach except to say that if a category is inherently suspect, adding dimensional ratings will not necessarily improve it validity.

In any event, there is a long history of research in this field. One leader is Robert Gibbons who is the director of the Center for Health Statistics at the University of Chicago. He has developed a computer based test that allows for flexible questions. This would replace traditional questionnaires that have a set number of questions that everyone answers. In these modern tests, the answer to each question determines what each ensuing question will be. The researchers argue that these questionnaires are more efficient. They are able to provide a diagnosis in as little as 12 questions (as compared to the 25 or 30 typical of the fixed question models). In order to do this, complicated computer algorithms are employed. Dr. Gibbons has received about $5 million dollars from the NIMH to develop the algorithms, which they call computerized adaptive tests.

Dr. Gibbons argues that the efficiency of these programs will allow busy clinicians to arrive at a diagnosis much faster.  A patient could sit with a tablet in the waiting room, answer a few questions, and walk in to the doctor’s office with a diagnosis.  Again, I am going to set aside the relative merits of this type of efficiency except to say that I sometimes wonder if the people who develop these ideas ever spend time talking to actual human beings who go to a doctor’s office seeking help for some personal crisis.

I will add that this type of approach will require access to the computer program with the algorithm. That is a product that could be made available in the public domain or could be sold.

So this is where it gets interesting.

Dr. Kupfer is a leading researcher and a big proponent for these types of assessments. The initial goal was to include them in the DSM-5 but in the end they were just included in a section indicating they needed more research.

Dr. Kupfer and some colleagues, including his wife, Ellen Frank, have been part of a research team with Dr. Gibbons. They have written several papers on their tests. One of them was published in Archives of General Psychiatry (now known as JAMA Psychiatry) in 2012.  When an author writes a paper for a journal, he is asked to sign a conflict of interest statement. Dr. Carroll learned that Drs. Kupfer, Gibbons, and Frank has all entered into a business, Psychiatric Assessment, Inc. that would sell the computer program. They failed to disclose this. When Dr. Carroll brought this to the attention of the journal, an apology was published. They then brought this to the attention of the APA, who issued their own report. What is particularly concerning is that along the way, Dr. Carroll wrote a letter to the Archives questioning the validity and value of this line of research.  The response from the authors was to suggest that Dr. Carroll was raising these questions not because of scientific concerns but because of his own COI, he is the author of a standard fixed assessment.  They wrote this during a time where they appear to well along the path to establishing their business.

1Boring Old Man  has written his own open letter to the APA. He has also detailed the timeline in his blogs which can be found in the links above.

One of the questions he has asked is why is this not receiving more attention. I held off on writing about this. First of all, it is complex and I wanted to make sure I understood the issues.  I have not been shy about posting but I admit to having worries about being naive and getting into something deeper than I appreciate at this time.  Secondly, I am not sure I have any significant influence. I have no idea who reads this, who reads 1BOM or any of these other blogs. I also think that the audience here is already convinced that psychiatry is corrupt. I am not sure what impact this will have.

But in the end, I decided that I had an obligation to use whatever platform I have to bring more attention to this issue. For me, one of the biggest problems we have in psychiatry is unacknowledged COI. Given the sensitive nature of the work we do, the power we can wield over people’s lives, the history of our improper relationships with Pharma – even if it turns out all rules were followed – that is not good enough. We should be above reproach.

Sandra Steingard, M.D.

Anatomy of a Psychiatrist: Dr. Steingard chronicles how she is integrating information from Anatomy of an Epidemic into her community mental health practice. She also discusses changes in Vermont’s mental health system and the influence of pharmaceutical advertising on clinical practice.


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50 thoughts on “Conflict of Interest, DSM-5, and the APA

  1. “… The audience here is already convinced psychiatry is corrupt,” does seem to be true.

    “Given the sensitive nature of the work we do, the power we can wield over people’s lives, the history of our improper relationships to Pharma – even if it turns out all rules were followed – that is not good enough. We should be above reproach.”

    You forgot to mention the unrepentant, massive societal psychiatric malpractice which resulted in the childhood bipolar epidemic. Every child (or adult) who had ADRs or withdrawal symptoms from antidepressants or any other drug MISDIAGNOSED (according to the DSM-IV-TR) as bipolar dealt with MALPRACTICE. And how does psychiatry address this almost unfathomable in scope malpractice problem? Do they confess to their ignorance, change their ways, and utilize their malpractice insurance for what it was intended? No. They turn bipolar into a spectrum disorder and claim antidepressants “unmask” bipolar. And change the rules in the DSM5.

    The psychiatric industry’s crimes against humanity are so hideous and unbelievably prevelant, your industry will never be “above reproach.” I know you’re trying, Sandra, and say thank you. But at this point I’ve personally concluded most in your field are likely the unrepentant hypocrites that Dante claimed belong in the lowest depths of hell. And my medical records show proof my psychiatrists denied the existence of the Holy Spirit, which is the one and only unforgivable sin in the bible. So it seems even God may agree with Dante on where the unrepentant hypocrites belong.

    Absolute power corrupts absolutely, and psychiatry has been absolutely corrupted. Forgive me, I didn’t talk too much about the topic at hand, largely because I’ve only read one article about that so far, but it’s just more lack of ethics, from the least ethical industry this planet has ever seen, historically and now.

  2. We are mostly a jaded bunch here, and I would guess many people here would chalk this up to one more example of corruption in the process of making the new DSM. However, there is an obvious smoking gun here as Kupfer has publicly acknowledged his COI and (sort of) apologized for it. I would hope that the detailed information that BOM discovered does not only go to the APA but also to publications like the NYT, The New Yorker, The Atlantic, etc. More light needs to be shined on this. I would guess that the end result may just be shuffling chairs, but it can also show further proof of the serious problems inherent in modern psychiatry.

  3. For those of you who want more, there are two more blogs on this today. One is part 2 from Neuroskeptic: http://blogs.discovermagazine.com/neuroskeptic/2014/01/25/psychiatrists-another-dimension-part-2/#more-4787

    He describes more about the problems of this being a closed sourced system. In part 3, he will discuss the utility of this approach and I am looking forward to that.
    The other is by Dr. Carroll, who broke this story.
    Here is a link to his latest:
    http://hcrenewal.blogspot.com/2014/01/windy-city-blues.html

    Here are links to Dr. Allen Francis’ blog on this:
    http://www.psychologytoday.com/blog/saving-normal/201401/holding-psychiatry-much-higher-ethical-standard

    And to Dr. Hickey(who blogs here as well):
    http://www.behaviorismandmentalhealth.com/2013/12/23/dsm-5-dimensional-diagnoses-more-conflicts-of-interest/

  4. Sandra,

    Dr. Nardo(aka, 1 Boring Old Man) writes:

    “The Trustees approaching this issue with integrity, open-mindedness, and thoroughness will go a long way towards restoring our reputation as the ethical medical specialty that we need to be, and set a new precedent that Conflicts of Interest will be thoroughly pursued.”

    Restoring its reputation?

    Really?
    Are you kidding me?!

    Have psychiatrists taken time to read about the history of the profession? What years, specifically has psychiatry *ever* had anything resembling a decent reputation? WHEN?!

    The problems in psychiatry go well beyond the freakin’ DSM 5; well beyond the latest scandal of some buffoon trying to rake in a few bucks off a phony algorithm chart(this has been tried before by the way, here in Texas)…

    Psychiatry uses poisons designed to cross the blood brain barrier. And this latest scandal is the field’s biggest problem? Really?

    IMO, it’s time to take a wooden stake, and place it straight into the heart of the profession.

    The world would be a much more civil and decent place without it.

    Duane

    • The Vampire can not be killed with a wooden stake in my opinion.

      This particular Vampire can only be killed with sunlight, as in exposure.

      Everyone (including the Government) must know the truth of the effectiveness of the drugs (not getting what the Gov is paying for) and the increasing percentage of the population deemed “mentally ill”( Government wants healthy people, not lifetime sickness).

      If people believe psychiatrists are doctors, they are doctors.
      If the people know psychiatrists are NOT doctors maybe something will happen. Doctors don’t jail their (innocent) patients. Doctors don’t drug their patient against their will. Doctors don’t lie about chemical imbalances. Doctors don’t give excuses for criminals choices of behaviour. Doctors do not damage their patients body or brain unnecessarily (Primum non nocere). A doctor knows a broken leg does not stay a broken leg forever. A psychiatric description/diagnosis must change over time and include the effects of the drugs the doctor issued to the patient (more drugs? more…)

      • Government doesn’t want “healthy people” they want compliant voters. “Exposure” will not kill this monster, it has already been “exposed” and is still living.
        The media is owned by corporate interests and Pharma interests, they decide what is exposed and what is not. For the public to know truth, the public must own the media.

        • The (general) public have to work at crappy jobs to keep a roof over their head, they do not have the time or energy to revolt.
          Only genuine doctors can fix psychiatry with genuine science.

          Feb 2012 National Geographic [“We can’t tell a schizophrenic brain from an autistic brain from a normal brain,” says Christof Koch]http://ngm.nationalgeographic.com/2014/02/brain/zimmer-text

          There is no physical disease in mental illness until drugs are issued.

          The public can only see one or two trees (anecdotal evidence), the forest can be seen by science.

    • Duane

      I’m with you. There are a few, like Sandra and some other psychiatrists who post here, who I would save. But for the most part I would stake the rest of them in a heart beat. They are allowed to ruin peoples’ lives with impunity and never get called into question nor do they ever get punished. It’s time to gather our stakes and get busy.

  5. As I noted above, I know for many readers on this site, this incident is small compared to other complaints you have with psychiatry. But I think there are some who are less sure. There are some who are struggling to figure out what our role can and should be. At the very least, we should live up to our own explicitly stated standards.

  6. I’m glad you posted about this, Sandra, because I think that issues like this are precisely indicative of what many of us feel the core problem is, here–lack of honesty and integrity for the sake of profit, as standard operational procedure. That may be the norm in the corporate business world, but when it occurs in health care, it should be scorned and deterred in every possible way, as it affects the community so adversely, blatantly betraying its trust. In mental health care, it downright crazy-making, which is the point of our protests.

    This particular conflict of interest may appear less dramatic as an issue, relative to horror stories we hear about how people are treated in this field, but it all amounts to general lack of ethics, as this would indicate. This ripples out in many ways. Where does it stop?? To me, it seems like a runaway train at this point.

    To be sure, I do appreciate *your* honesty and integrity, you speak clear truth, thank you.

    • I woke up this morning still thinking about this post, so I figured I had something else that I needed to express about this, as is often the case when I allow myself to think about my former life as a psychiatric patient.

      Even though I’ve completed my journey with this and have moved on to simply and mindfully living my life as an integrated and creative human being, I find myself drawn to every opportunity possible to speak, at least, an aspect of my truth about psychiatry. If nothing else, it sure does help me move forward, so I can continue to get on with my life in a more settled way, working toward achieving inner peace from these experiences. These issues can feel rather sticky and loopy, like all post-traumatic stress. Thank goodness for MIA.

      I apologize for my comment, here, being broader than the scope of the article, but no matter how much time has passed since I took my last pill or since I came face to face with any kind of therapist, there is still a sizeable pit of shadowy chaos which gets triggered when I allow myself to think back on my life as a customer of the mental health industry. Kind of like turning to salt when I look back, although it’s almost a guilty pleasure. So many surreal and strange aspects to a journey through ‘mental health treatment.’ I’m still learning a lot, as new insights surface, and it’s informing my life path, clearly.

      “What a long, strange trip it’s been.”
      Grateful Dead

      Using methods that are working well and to completion for me, I’ve worked very diligently to heal from the post-traumatic stress (both physical and psychological) that was caused by my particular series of experiences. PTS occurs when one is not allowed to express their true feelings at the moment they occur, or not processed reasonably afterwards. This occurs way more often than not in mental health care, I think it’s the norm.

      Speaking my truth now and forever is what will keep me up-to-date with myself, so nothing festers, as it does with psychiatric clients, because their truths are so invalidated in myriad ways, as mine were for so long. First thing that occurred when I abandoned psychiatry is that I reclaimed my self-esteem and independence of mind. They had sucked me dry of these.

      Now that I can at least compartmentalize this, so that it doesn’t filter into my self-perception or into my relationship life, so much is coming to light daily, in my relative clarity about these experiences with mental health clinicians, and it’s informing me well about many things—most importantly, how to shift my own energy so that I can create what I want now, in a forward moving way. It’s my own fault I got stuck, but that’s because I trusted psychiatry, from my own upbringing. I thought it was the way to go for anxiety and depression, as many still do.

      It’s hard to know where to begin, although I don’t believe it’s necessary for me to say anything, here, because it’s all been stated on this website, in many ways, repeatedly.

      To me, “What is ‘sound’ mental health?” would inherently have to be agreed upon by a community, as the nature of this question really falls into the category of ‘cultural norms.’ Still, from my perspective, whatever this is (feeling good about yourself, maybe?) would most likely be cultivated in a space of permission, creativity, integrity, loving compassion, and unmitigated validation for the heart’s truth of the one who is seeking healing and personal growth. I don’t recall any of these qualities in any of the clinicians with whom I worked, or in any of the mental health agencies which I attended. Quite the opposite—very constricted and rigid, emotionally and intellectually. Zero spirituality of any kind, not even remotely. In fact, it was largely ridiculed.

      People who are traumatized, confused, despondent, fearful and who turn for support should be able to expect role models in terms of honesty and generosity of spirit, and instead, with current mental health care and psychiatry, they fall into a nest of greedy, narrow-minded vampires. What you describe above, in this article, is pure vampirism. These are our role models? This is what creates rage within a population!

      Apologies are transparent and weak when you are caught red-handed lying and stealing like this. For crying out loud, these are adults who have a job to do for the public, they’ve taken an oath! I know this sounds terribly naïve, but I like remembering this perspective. Adults aren’t the same as when I was growing up. Even though there have always been troubled people in the world, I do remember when there was at least some recognition of emotional maturity among the adults, at least in my environment this was the case. These days, I feel like I’m dealing with overgrown kids when I interact with the world. No direct communication, all acting out, just like kids. In psychiatry, it was like being with the schoolyard bullies. A lot of arrested development in this field, I discovered—the tragic irony of it all.

      A good role model would be humble enough to change his or her ways when they get caught with their hands in the cookie jar. That would really be so healing for all concerned.

      I look forward to the day that we have broken free of these discussions, because that would mean that the planet has finally awakened. As much as I gain from speaking my truth, these kinds of truths don’t feel terribly joyous to express.

      This is the time that I turn off my computer, take a deep breath, and take a walk in the woods that are next to my home. I’ll probably stop and get a latte somewhere along the way. The sun is shining today. It’s Sunday. This is what brings me joy.

  7. I sent this to Sandra via email but I think it belongs here too.

    First, I have to say that I have come to respect you more from your first postings in MIA in which you looked like the female version of Dr Moffic. I still have qualms with some of your positions, like coercive psychiatry, but still, I think that you have grown into somebody I can respect.

    With this said, I find this fabricated outrage quite comical.

    And since I like humor a lot, I would illustrate the issue with a joke about San Francisco that was very popular among conservatives like yours truly years ago. I do not find the internet reference, so it must have lost some popularity. I have to retell it using my own words, which might not be as funny.

    The joke was something like this. It talked about a party attended by the mayor and the San Francisco elite. The party was full of the usual negatives about San Francisco that have become anathema in the conservative consciousness: wild alcohol consumption, heavy illegal drug usage (cocaine, crack, heroin, etc), sessions of group sex, old gay men having sex with minors, etc. Suddenly the mayor decides to pull a stunt in the middle of the room with a dominatrix and a bottle of Vodka with everybody watching. The mayor is unlucky and the bottle falls to the floor where it is left for the remaining of the party.

    The next day, the San Francisco Chronicle, upon learning about the party, decides to take the story to its front page in a responsible exercise of investigative journalism. The headline “San Franciscans express outrage that their mayor doesn’t recycle bottles of Vodka in his parties”.

    It must be an “insider thing”, but seriously worrying about this when people are dying everyday of the effects of the drugs that psychiatrists prescribe to treat psychiatry’s invented diseases seems like a practical joke that only psychiatrists can understand :D .

  8. Essentially two different gangs of drug dealers are arguing over spitting up the profits. One group has developed a new computer blue super meth that should bring in more profit the other gang leader say they broke the meth gang rules and says it’s so unfair because maybe they can get their own super computer blue meth in at the finish line.

    No one care how this new super meth affects the addicts not even Sandra the gang rep news agent. ie “Again, I am going to set aside the relative merits of this type of efficiency”

    So what to do?. I know , lets ask the relatives of the addicted lobotomized drug users. How should psychiatria death drug dealers spit up their loot? Surely they will know what is fair and what is not?

    Oh and someone protested to the board of Capos but maybe the fix is in – looks like maybe someone greased the fuzz.
    So when the corruptors are corrupt who u gonna call?

    Ah gee, I donno whatasay. What kind of advice to give a squabbling cartel?
    Somehow I think my intelligence was just beaten with a sledgehammer.
    ——
    How about Lesson One from Vito Corleone?

    “Vito is offended, replying, “We have known each other many years, but this is the first time you’ve come to me for counsel or for help. I can’t remember the last time you invited me to your house for a cup of coffee, even though my wife is godmother to your only child.” Don’t show up only when you need something.

  9. “For me, one of the biggest problems we have in psychiatry is unacknowledged COI. Given the sensitive nature of the work we do, the power we can wield over people’s lives, the history of our improper relationships with Pharma – even if it turns out all rules were followed – that is not good enough. We should be above reproach.”

    No, I think the biggest problem you have in psychiatry is that psychiatrists learn absolutely nothing , Zero, zilch about human psychology, the mind , the emotins and how they function.

    Psychiatrists are not vetted through any process of inner development nor are they vetted by any process of ego stripping and emotional confrontation. Part of the final exam should be an eight hour group confrontation process in which their innermost processes are examined and it should not be easy to pass.

    the rules were followed

    This is self-delusional, whose rules? The bought off judges,?the bought off politicians? the bought off mental health workers? the corporations? the power elite? the rules of the shrinks , the self-appointed gods?
    Pschiatria is above reproach only because it is above and beyond the law.

    • I do believe that when psychiatrists still did actual talk therapy that they were required to undergo analysis themselves. This may have been of some help in putting them in better touch with their humanity.

      Now that there is no instruction about talk therapy in med schools for those wanting to be psychiatrists they are never required to look at their own “stuff” and evaluate where they are as a human being. Almost none of them have done their own Work and you can smell it on them when they walk into a room. They stink of not understanding their own motives, desires, and emotions. All they know how to do is shove the toxic drugs on people and they do this very well.

      Every once in a while a few of them actually do stop and begin evaluating their own lives and begin doing their own Work. Some of them even find their way to MIA. But they are far and few between. I believe you are correct when you state that psychiatrists learn absolutely nothing. All doctors in all specialties are narrowly educated in med school rather than receiving a broad education. All psychiatrists learn to do is write out the prescriptions. There is nothing scientific behind the toxic drugs. The least they could do is learn to write legibly so that the scripts could be understood more easily!

      • Yes, I have a parent 90 years old going through that abuse right now. I woudl move them, but there is nowhere to go – they are all the same and despite “it’s not supposed to be”, every phone number for reportage goes into a bureaucratic loop.
        They own it lock stock and barrel – the corporations and Government in lockstep.
        Also they got kickback from one particular pharma company and locked out all other suppliers to the corporate chain – even the pharmacists complain – once they’ve gone to long term corporations all the records they used to have access to, go into a black hole.

        • Sorry to hear about your parent. Corruption has made its insidious way into everything so that our children and our old people are no longer safe. It’s difficult to combat since it’s on such a broad scale and it does start in Washington and in our state governments where the politicians are taking kick backs and money under the table right and left.

      • Psychoanalysis is to Psychotherapy as a turtle is to a cheetah.

        I read Jan Wong’s description of her psychoanalysis in “Out of the Blue”, and felt like throwing the book at the wall. What a colossal waste of life! She did the medication route with psychoanalysis for all the good it did her IMO.

  10. In the book “We The People” by Thom Hartmann he talks about a law that was shoved through Congress in 1979 which officially gave individual corporations the same rights as a human being. In the past for example during the times when Teddy Roosevelt was President and he was able to successfully fight the “robber barons “. If a corporation did something that endangered the people the corporation could be taken to court and possibly even be dissolved. This can no longer be done since 1979 because of the change in the law. Hartman says that repealing this one law that gives a corporation the same rights as a human being would unravel their power and give it back to the people and win us democracy.This is to my best understanding.
    I am not a lawyer ,and I wonder if the lawyers that post here at MIA (Maybe Ted and Tina) could give us more fuller info. on this as pertains to removing the deadly power of Pschiatria

  11. I hope at least this shines a bit of light on Robert Gibbons and his “Center for Health Statistics,” which has made a cottage industry out of dubious statistical analyses to benefit the pharmaceutical industry. The most notorious has been their efforts to topple the Black Box Warning on youth suicide and SSRI’s with studies based on data from industry, provided only to them. But trust us, they say, it proves there’s no link between suicide and SSRI’s.

    They have provided the same service for other drugs associated with suicidal impulses, including the anticonvulsant Neurontin and the asthma medication Singulair, which has been linked to suicidality particularly in children.

    Robert Gibbons has been well rewarded, at least … In November of 2010, after 30 years at the state university, he and his entire “Center for Health Statistics” moved on up to the University of Chicago, Pritzker School of Medicine. And a few months later Gibbons was named a Pritzker Scholar for 2011. What’s that, you ask?

    “The Pritzker family of Chicago, widely known philanthropists whose many business ventures include the Hyatt Hotel chain, made a gift of $30 million to the University of Chicago in 2002. The gift has been used to recruit outstanding new faculty to the Biological Sciences Division of The Pritzker School of Medicine. These Pritzker scholars form uniquely synergistic and powerful groups of investigators. To date, there have been 18 Pritzker Scholars.”

    You won’t be too surprised to learn that a lot of the Pritzker family capital is tied up in pharma and biotech these days. Or that family spokesperson Penny Pritzker was and is Obama’s top fundraiser. The relationship between Pharma and both parties remains pretty “synergistic and powerful.”

    To their credit, Bernard Carroll and John Nardo fought hard to unmask the Gibbons study “exonerating” SSRI’s. Maybe this latest scandal will finally unmask an academic “center” that to me at least looks like nothing more than a stable of hired guns for the pharmaceutical industry.

    • Interesting – cataloging or recording the apocalypse you are.
      Good work.
      I wouldn’t get your hopes up.
      ..
      The black box warning hasn’t stopped the rampant use of psychotropics on the elderly in Alberta Canada where they are literally being murdered in droves.
      ..
      Black Box warning sure – but who knows about it? The long term care places give out no info, neither do the doctors nor the pharmacists nor the Government Health Services nor the media.
      They do as they wish.
      A conspiracy of silence – everyone wants to keep their jobs.
      All the official numbers for complaints are a Franz Kafka Bureaucratic joke.
      Also almost all of the relatives of those elderly are fooled blind.
      A perfect patsy population.
      Don’t get your hopes up.

      • You are correct. Nursing homes have become a great money making proposition for the drug companies. Huge amounts of the so-called “antipsychotics” are used to drug anyone in nursing homes who causes any kind of “problem” for the staff. If you speak out about the poor care you receive, or if you don’t want to go to bed at 6 PM when the staff want to put you to bed, or if you complain to your family about what’s going on, you will be drugged until you sit locked in your gerry chair, drooling and urinating on yourself mindlessly.

        I was the chaplain of what is referred to as a “good nursing home” and I saw this kind of activity against the residents all the time. And when you speak out in favor of the residents your services are suddenly no longer needed at that particular nursing home. Children and the elderly are the new targets of big pharma.

  12. In many ways, the education I’ve gained here at MIA has been life changing following the death of my 25 y/o son, two yrs ago. I hold the blatant failure of the MH “system” mostly responsible. I so appreciate Dr. Steingard’s post about the COI in this field of psychiatry. After linking to a later blog she posted, reading Dr. Bernard Carroll’s blog (who actually broke this story) I remain dumbfounded how ETHICS is absent amongst these professionals. And my son’s tragic death, along with countless other victims of this industry, have paid the ultimate price. I want to believe that violations of the Hippocratic oath these physicians took years back could be used legally against them?
    But in the bigger picture, as I look around me, especially after losing my first-born son over the 2+ years he was caught up in this tainted, broken MH system the rosé-tinted glasses I wore for decades are off. It saddens me beyond, to see society in this new light. I completely agree with the post by Alex! But I realize it’s not just the psychiatric industry that has become so unethical. The loss of social trust- the belief in the integrity and honesty of others- is purasive across all industries in America. Without social trust, corruption runs rampant. Where do we, as a society, go if there is little trust in the foundations that should help us find healthful ways to save a person who experiences some severe emotional crises, regardless of the cause(s)?

    • Million dollar question, Larmac. Where do we go now?

      A friend just sent me an article about NSA surveillance by author and researcher David Wilcock, and in it, he describes the effects of such societal betrayal. I feel that what he says applies perfectly to what we’re experience as a result of the decay of ethics and humanism within psychiatry, and the mental health field, in general–

      “For most people, such a basic betrayal of trust from our so-called ‘authorities’ is a horrible, isolating, terrifying feeling….This ‘ugly’ feeling actually has a name and a purpose. It is an archetype — i.e. a blueprint of consciousness that appears to be written into the ‘collective unconscious.’ The name of this horrible, chilling, terrifying moment in our life’s journey is the Dark Night of the Soul.”

      Seems we’re in a collective ‘dark night of the soul,’ with psychiatry smack in the center of it. I agree with you that this has permeated throughout our entire culture. Yet, the tragic irony here is that we’re turning to psychiatry and mental health services for our emotional distress, and what happens is that we get sucked into their darkness, without realizing it. We trust, they betray.

      So how does one get through the Dark Night of the Soul, to reach light? I got through mine, and it was not easy. It’s not supposed to be. It’s where we learn our strength, voice, power, tenacity, and forgiveness. It’s where we learn to self care by being loving to ourselves, and this makes it possible to be genuinely loving toward others.

      One by one, we take our inner journeys, and from that, a new society will be created. It already is. There are many healers all over the planet now who work with ‘the light.’ This is my primary peer community, this group of light workers and healers.

      Integrity is an agent of healing. I know that it’s like looking for a needle in a haystack these days, but integrity does exist in small pockets of the world, and I believe it will eventually thrive. Perhaps not in everyone’s reality, since in order to create something, we actually have to believe in it, first. But for some of us, reality will be better, because we believe that such change can occur, one way or another.

      Given the public outrage occurring around the mental health industry, I believe the deceivers are finally feeling their own pain. And we who fell for the deceit at one time are getting stronger and clearer, and more aligned with our truths. Whatever happens now, it will be a fascinating journey out of this dark night and into the light.

      What will it finally take to blast all this density and resistance that psychiatry puts up? I wonder.

      • About a dozen years ago I had one of those moments of clear clarity. I realized that concerning human beings in any encounter with another if there is not friendship between them then there is not much going on at all.

  13. Sandra – thanks so much for this post. One more candle in the dark. I appreciate your transparency and integrity in writing it. I understand your doubts about what impact it may have, but few people who speak truth to power can have any assurances – please keep it up.

  14. Gosh, maybe we can create a computer program that uses this kind of assessment tool, and once the computer comes up with a diagnosis, we put in our VISA card and out comes a prescription!

    We have sunk to a pretty low place when psychiatrists are even able to THINK about using a computer to “diagnose” a human being who is suffering. It simply underscores the complete moral bankruptcy of this profession and its approach to mental/emotional/spiritual distress. The answer does NOT lie in being more “objective” about “symptoms,” as in treating people like both you and they are machines!

    Yes, I know there are far worse crimes being committed, but somehow, this just underscores how hopeless it is to try and “reform” an effort that is this corrupt and out of touch with reality. Thanks for the info, Sandra, but I came out of this feeling exceedingly disheartened.

    —– Steve

    • Steve

      Making the human connection and appreciating the humanity of others around us has no value in psychiatry.

      When I was given my wonderful little diagnosis the psychiatrist was cold and inhumane. The only time he looked at me was when he screamed at me that I was stupid because I was mourning the murder of my younger sister; I’d just received the news the day before. We spent maybe fifteen minutes together, if that long. I thought that perhaps he was an aberration since I’d never dealt with psychiatry before. I quickly learned that he was pretty much the norm to expect from this corrupt and ignorant so-called “medical specialty.” They don’t value people and being able to make a human connection is not a requirement for them to practice.

      • Yeah, jeez, she’s dead already, why don’t you just move on? Ugh! Such callousness is incredible! I knew a psychiatrist who had seen a depressed woman for 15 years and never even bothered to ask her what she was depressed about. Another (developmentally delayed) teen woman was hospitalized with ‘bipolar’ when she hadn’t acted out in any way until she disclosed being raped a year before. Took me 10 minutes conversation with her mom to find out what had happened. Obviously, they simply didn’t care enough to have asked. It is disgusting beyond belief. So sorry you had to learn that the hard way. For the most part, they really don’t care.

        —- Steve

        • I informally interviewed a lot of “consumers” at a MH dropin centre – same story over and over again , just like what you are saying.
          Nothing that ever happened to them or is happening to them matters, you see, because they have a brain disease.
          Many of them with outrageous histories of violent abuse,and another thing – they have constant groups in which they are prohibited from saying anything “negative” and must to tell some kind of lie about how they feel today etc. When I participate in those groups, I find I have to hide who I really am, what I do and what my life is really like, and make up a fake self to present, which is fine with me because I am a spy lol but feeling of having to present this false image of self is horrid and twisted.
          It’s the ultimate betrayal of those who are trusting damaged and confused on meds.

          Canada on national TV has this week has a big Mental Health “awareness” week – lots of doctors telling how to use medications, lots of paragons explaining how they now take their meds everyday and they are just fine and it’s justifiable you see, because the whole population is about to commit suicdie.
          Everyone needs “treatment”.
          Pretty scary.

  15. I read this stuff. I’m a nurse working in critical care, and also someone who has chosen to interact with psychiatrists as a patient for many years. I think its good you highlight the tricky nature of raising this issue. Clearly psychiatry is in need of a major re-think/re-structuring. Then again, the world in general is in need of a major re-think/re-structure. That is to say, the issues in psychiatry are part and parcel of larger fundamental problems we face in terms of the privatization of healthcare, the capitalist global economy, etc. If we are able to take an even broader historical perspective, it becomes clear that we are in this mess not simply because of bad actors such as Kupfer, etc., but for particular conceptions of the mind, body and self that originated hundreds of years ago. Without a recognition of the specific ideas that have helped lead us to this mess, we have no hope of ever finding true freedom for ourselves, or our patients. Thank you for raising the issue of how to address these issues beyond the dualistic paradigm that is so troublesome to break out of.

    • I think you’ve hit the nail on its proverbial heat. One of the huge problems with medicine in general is the narrow education that doctors receive. They don’t delve much if at all into the Humanities and most of them couldn’t fight their way out of a wet paper back when it comes to philosophical debates and conversations.

      We are all too narrow, too specialized, to limited to our own little worlds and we don’t care to educate ourselves about how we got here and where it’s going to take us if we don’t watch out. Thanks for pointing this out.

    • Well put. I have come to these same conclusions and it is what makes me uncomfortable here sometimes with the narrow focus on psychiatry alone. That is not to justify psychiatry but to point out that solutions such as referring everyone to neurologists or “real” doctors, will not fix the problem. Thanks for the comment.

      • I feel uncomfortable here sometimes as well, when all roads lead to talk therapy… when the basics are overlooked.

        Every doctor ought to be smart enough and wise enough to rule out some very basic physical causes, before assuming anything.

        Look for head injuries, thyrroid issues, sleep disorders. And for those too lazy or ignorant to do so, step out of the way… stop doing more harm than good.

        See Chapter 2 -

        http://www.operationflyingpublisher.com/pdf/FPG_008_ComplementaryandAlternativeMedicineTreatmentsinPsychiatry_2012.pdf

        Talk therapy for a thyroid condition?
        Brilliant.

        Duane

        • And the one-size-approach to open dialogue (or any other talk therapy approach) is not going to get this done.

          There are folks out there with *real* physical conditions who need care… not just talk.

          I can appreciate the role of talk therapy. But when a head injury, thyroid condition or sleep disorder is not being addressed, all I can say is: talk is cheap!

          Duane

          • And Sandra, I don’t regret using the term “real doctors” to differentiate neurologists from psychiatrists. The first group treats illnesses of the brain, the latter, the mind.

            In the case of severe epilepsy, etc, a case can be made for anti-convulsants, but with “bipolar”? A wake-up call to any and all shrinks: Mood swings are not seizures!

            Duane

          • Duane,

            I know someone who dealt with “real” doctors who fired her as a patient and demanded that she see a psychiatrist. This “fake” doctor referred her to great “real” doctors and didn’t medicate her.

            Look, as one who doesn’t think too much of psychiatry in general because my horrific experiences, I understand the anger. But with all due respect, if people think that “real” doctors are any better generally, you are sadly misguided.

            They too will prescribe psych meds as a one size fits all solution and will do the same with meds. And of course, they will spend two minutes with you before shoving you out the door.

            Regarding neurologists that you think are so great. I dealt with one who wasn’t. And there is no doubt in my mind that if I had disclosed my psych med history, he would have saw that as the answer. Your mileage will vary.

            I do agree with you as one who has sleep apnea that unless physical issues are addressed, talk therapy isn’t going to go very far.

            AA

          • > And the one-size-approach to open dialogue (or
            > any other talk therapy approach) is not going to
            > get this done.
            >
            > There are folks out there with *real* physical
            > conditions who need care… not just talk.”

            My understanding of Open Dialogue is that it is not restricted to talk therapy. It’s about figuring out together which support is most helpful and not jumping to premature conclusion. If there were the assumption that a real physical condition could be a cause of the emotional distress, there would be support in finding the right physician. (That is how I imagine Open Dialogue)

          • We need more like her:

            https://www.madinamerica.com/author/kbrogan/

            Oli,

            I’m all for Open Dialogue; for whatever works. I’m also against any one-size-fits all approach, whatever the approach.

            I’ve read the recovery rates with Open Dialogue are very high. From what I’ve read, there are no pre-conceived notions for what might work for any individual.

            Which makes me quite curious about your adamant stand against acupuncture (another post)… Are you saying that Open Dialogue is based on hard science? Really? I’m not saying it needs to be. But your appreciation for a humanistic approach with Open Dialogue seems to counter your desire to bash the ever-lovin tar outta acupuncture….

            Just sayin’.

            Duane

  16. Conflict of interest, guess that explains why there is DSM no billing code for antidepressant dependency despite the well known problems with withdrawal. Same with the other so called ‘non addictive’ psychiatric chemicals.

  17. This line get bringing me back to this post:

    “Given the sensitive nature of the work we do, the power we can wield over people’s lives…”

    The idea of someone wielding power over my life creeps me out, which is why I abandoned mental health care, altogether. It was easy to know that this was the belief of clinicians. In graduate school and during my training, I was guided to believe this, and I rejected the idea, altogether, that I had power over anyone. One of my supervisors would remind me, “Don’t give your client too much power.” I could not believe this was my supervision. A person heals when they know, own, and operate from their own power, to me that’s just common sense. I don’t believe it’s accurate nor humanitarian to believe that this would not be possible for someone, to own their power. We are all entitled to this, 100%.

    As a healer and teacher, I continuously remind people that the only person that has control over their lives is themselves. They don’t always like hearing this, because it can create an overwhelming feeling of burden and victimization, rather than being welcomed as self-responsibility–which is good news, because then you have control over your experience. Still, there is a lot of resistance to letting go of co-dependence, and it’s my job to not fall into that pattern with a client, as tempting as it can be, sometimes, simply to avoid feeling guilt. Guilt is a powerful weapon of control and manipulation, and it is used readily. I can’t tell you how many times a clinician has told me that I’ve ‘hurt their feelings’ when I would give them my honest feedback. I wouldn’t know whether to laugh or cry when I heard this.

    In the end, it was maddening because no real communication–nor, needless to say, any healing at all–would take place. All they wanted was to have power over me, as this was a programmed belief in their minds, which would always lead to my departure from their practice, until I got that it this was a problem of epidemic proportion in the mental health world. That’s when I saw how incredibly limited current mental health beliefs and practices really are.

    Believing that anyone has power over anyone else is buying into many illusions. I’ve witnessed clinicians manipulate, purposefully trigger, threaten survival, coyly remind others of their ‘place,’ and for sure that instills fear and shame to the point where they are so vulnerable and with no sense of self, that it is easy to believe they are easily influenced and controllable. But that is blatant manipulation, not anywhere near being truly powerful.

    At the core of our humanity, no one has power over anyone else. That would be a clinician–or anyone with this delusion– believing they are God.

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